Review articleChallenges in reducing the burden of otitis media disease: An ENT perspective on improving management and prospects for prevention
Section snippets
Otitis media
Otitis media (OM) is a major public health concern. Acute otitis media (AOM) is the most frequent disease of childhood, affecting millions of young children worldwide each year [1], [2]. AOM is a leading cause of physician visits and a major contributor to healthcare costs [3], [4], [5] and antibiotic use [3], [6], [7]. Furthermore, a substantial reduction in the use of antibiotics to treat AOM in children under two years of age is expected to help decrease bacterial resistance to antibiotics
Global burden of OM
OM is a continuum of disorders starting with a single episode of AOM that can notably progress to recurrent AOM or OM with effusion (Fig. 1) [13], [14]. AOM occurs in almost all children, and epidemiological data suggest that, by three years of age, 75–80% of children will have had at least one episode, with the peak incidence occurring before the age of two years [2], [15], [16]. In addition, more than 60% of episodes of symptomatic upper respiratory tract infections among children under three
Diagnosis of AOM
Although the presenting signs of AOM are well characterized, they are often non-specific and variable, complicating differential diagnosis [9], [26] (Table 2). A diagnosis of AOM requires a rapid onset of symptoms, the presence of middle ear effusion (otorrhoea or tympanic membrane changes), and signs of middle ear inflammation (otalgia or erythema of the tympanic membrane) [10]. Furthermore, there are no clearly identified prognostic indicators to help physicians determine which patients are
Vaccination as a potential solution to the universal problem of AOM
Paediatric vaccines have dramatically reduced the rates of invasive bacterial infections, which pose a morbid or potentially lethal threat to young children. Vaccination against H. influenzae type b, for example, has led to dramatic reduction in meningitis caused by this pathogen [50], [51], and vaccination against S. pneumoniae (7vCRM) has helped to lower the rates of meningitis, septicaemia, and pneumonia [52].
The 7vCRM vaccine offers limited protection against AOM. In the Finnish Otitis
Conclusions and recommendations
The diagnosis and management of OM remains a challenge, as there is no correlation between symptoms, the responsible pathogens, and the development of severe complications. Treatment of AOM is therefore not always appropriate (Fig. 2).
Current guidelines recommend watchful waiting or empirical treatment with antibiotics, but they do not provide guidance on which individuals are most at risk for severe or complicated disease. Complications such as recurrent OM contribute to the continued high
Acknowledgements
The First International ENT Roundtable Meeting was sponsored by GlaxoSmithKline Biologicals. This publication was sponsored and reviewed by GlaxoSmithKline Biologicals. We thank Dr. Winnie McFadzean (LiveWire Communications) and Dr. Julie Harriague (4Clinics), who provided medical writing services on behalf of GlaxoSmithKline Biologicals; Dr. Valentine Wascotte (GlaxoSmithKline Biologicals), Dr. Bernard Hoet (GlaxoSmithKline Biologicals), and Karen Palmer (LiveWire Communications) for
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